Locoregional control in patients with palpable medullary thyroid cancer: Results of standardized compartment-oriented surgery

Background. Extent of neck dissection is controversial in patients with palpable medullary thyroid cancer (MTC). Methods. We evaluated 64 MTC patients (19 hereditary, 45 sporadic) with palpable thyroid nodules (group 1, n = 35) or palpable lymph node metastases (group 2, In = 29). Standard surgery included total thyroidectomy, central compartment dissection, and additional neck dissection on indication. Results. In group 1, 40% of the patients were cured. Thirty-one percent of all patients had central, 23% ipsilateral, 14% contralateral, and 14% mediastinal, metastases. Fifty-one percent developed locoregional recurrence. Locoregional recurrence (p =.043) and reoperations (p =.020) were noted more often after a less than standard initial procedure, In group 2, no patients were cured, All had central, 93% ipsilateral, 45% contralateral, and 52% mediastinal metastases. Thirty-eight percent developed locoregional recurrence. Conclusions. Locoregional recurrence frequently occurs in palpable MTC, and tumor control may be improved by standard central, bilateral, and upper mediastinal neck dissection. (c) 2007 Wiley Periodicals, Inc.